Many individuals believe getting that
first driver’s license a right of passage – a testament that
adulthood and freedom have arrived. In light of increased scrutiny
and legislation concerning older drivers, caregivers and aging
patients are both starting to wonder when to continue driving, when
to slow down, and when to stop driving altogether. Physicians have
joined in the ranks of those who are questioning the safety of older
adults behind the wheel of a car.

There are valid reasons for concern. The Federal
Highway Administration (FHWA) states that drivers over age 75 have
the highest motor vehicle fatality rate than any other driving group
with the exception of drivers under 25. In addition, this same
driving group has more motor vehicle accidents per miles driven than
any driving group except teenagers. Finally, as age increases,
drivers are less able to cope with the complex driving conditions
and are more likely to be involved in multiple vehicle accidents at
intersections.

Some studies have suggested that changes in the
vision field can contribute to the increase in older drivers who are
involved in accidents. Both visual acuity and visual depth
perception are affected, resulting in lowering the overall field of
view for the aging driver. Reaction time or the ability to adapt to
changing driving conditions also changes with age, although some
studies are unclear as to the complete effect this changing
condition has on the ability of an older adult to safely drive.

Prescription medications can also have an effect
on someone’s ability to drive. Seniors take more prescriptions daily
than other groups, with studies estimating this number between two
and seven. Some drugs interfere with hearing and someone’s ability
to react to driving conditions timely enough to avoid an accident.

Family/Caregiver Responsibility:

Many family members or caregivers are
understandably hesitant to tell their loved one that it’s time to
cut back on driving or stop driving all together. Staying
independent in the home as long as possible can keep spirits high
and decrease someone’s susceptibility to depression. Still, there
are some circumstances that warrant a caregiver taking steps to
ensure their loved one’s safety and well-being.

One of the best ways to determine if an older
driver is having problems driving is to be in the car as a passenger
to observe what happens during real driving conditions. It may take
several trials to get the full scope of what could happen. Driving
ability could vary by the time of day, how soon a person drives
after taking medication, or at night.

There are several questions caregivers can ask
when looking at whether or not it’s time to limit or stop driving:

1. When exiting a highway or interstate, does
the driver seem confused?

2. Does the driver seem nervous or
agitated when driving?

3. Does he/she fail to stop at red lights or
stop signs?

4. Is there confusion over the gas or the brake
pedal?

5. Are there unexplained dents in the paint of
the car, mailbox, garage, or other objects/vehicles at the
home?

6. Can he/she read and understand traffic signs?

7. Does the driver stop for no apparent reason?

8. How do other drivers react to the older
driver on the road?

9. Are turns, especially left ones, difficult to
navigate?

10. Is he/she aware of potentially dangerous
situations or activity on the side of the roadway?

While these are not the only areas to consider,
they will provide the caregiver with a method to begin evaluating
how well the older driver is navigating on the roadway on their own.
An objective evaluation is necessary in order to take the steps to
keeping loved ones safe while on the road.

Some older drivers start to ask for help or
naturally slow down in their driving innately as they become more
uncomfortable. For instance, some will stop driving at night if they
have difficulty seeing. Others may only drive during early morning
hours when they feel like their facilities are sharper. Still others
may ask for a co-pilot when they make regular trips to the doctor or
grocery store as a way of “checking themselves.” Caregivers should
also consider these cues when making an evaluation.

Next Steps:

After the caregiver or family has decided that
the driver should limit or stop driving, begin to have honest
conversations with them about their ability to drive. Defensiveness
about driving ability is common and older drivers often feel as if
their independence and livelihood are threatened by handing over the
keys.

Another way to approach the situation could be
through the driver’s physician. The physician can evaluate for
specific medical conditions that are hindering a person’s ability to
drive. For example, a person with cataracts may be able to have
surgical intervention that could increase their field of vision and
improve their driving skills. After a thorough exam, a physician may
also decide that a person is no longer able to drive. Hearing the
news from a doctor could be easier to accept than when a loved one
provides the same message.

Laws vary from state to state regarding
continued licensing of older drivers and a quick call to the state’s
transportation or public safety office could give more in-depth
information. For example, some states require drivers to retest
after they reach a certain age or have more frequent eye
examinations. Others may require a physician’s letter stating they
are physically fit. By the same token, other states are silent on
the issue, leaving it up to individual responsibility to decide if
they are fit to continue driving. The doctor may also be willing to
provide a statement for the family that can be attached to the
person’s driving record noting restrictions as well.

If he/she fears losing the driver’s license as a
valid form of identification, all states offer the option to provide
a legal ID card that does not include driving privileges. Generally,
these IDs are provided by the same office where someone would apply
for a driver’s license.

Alternate Transportation:

If the decision is made for someone to stop
driving, it helps to ease their anxiety that transportation could be
readily available. These arrangements could be made within the
family or caregiver circle or by researching available
transportation in the community. Some ideas for transportation
include:

1. Selling the family vehicle and setting aside
those funds to pay for public or private transportation.

2. Rotating a schedule with family members or
friends to provide ongoing transportation.

3. Qualifying for special transportation in the
community based on medical need, especially for medical
appointments. (For starting points on where to find these programs,
visit www.211.org.)

4. If public transportation is available, most
communities have para-transit options available for those who are
unable to walk to community bus stops. Applications need to be
signed by a physician or a social worker documenting that the
person needs door-to-door service.

5. Joining an existing neighborhood carpool or
vanpool service.

6. Senior centers may provide transportation
directly to and from programs on a regular basis. Additional trips
may be available as needed or as scheduled; some fees could apply.

These are only a few of the many alternate
transportation methods that are available. It is important to
emphasize that it is still possible for someone to be independent
and live on their own in the absence of a car and a driver’s
license. It is natural for someone to be anxious or even depressed
about not being able to drive. In order to address these concerns,
caregivers and loved ones need to continue communicating about the
need for transportation and how those needs can best be met.